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We describe and evaluate the introduction of a trauma family support service (TFSS) in an Australian tertiary paediatric hospital. A longitudinal mixed-methods cohort study evaluated the effectiveness of the TFSS on quality of life. PedsQL4.0 and EuroQol 5D-Y scores were collected at 6 and 12 months at intervention and non-intervention sites and outcomes were compared using a two-sample t -test. Qualitative data from field notes collected during the administration of the quality-of-life measures were analysed using inductive content analysis. Data were integrated during the interpretation of results to expand and strengthen findings. Data from 192 children were collected (intervention site: 104, control site: 88). Significant increases were seen in the PedsQL and EQ-5D-Y scores at the intervention site compared to the control site at both timepoints, indicating an increase in overall health related quality of life. Two main categories were generated from the qualitative analysis: "Psychosocial impact of trauma" and "Access to psychosocial services." The introduction of a dedicated family support service after paediatric injury improved well-being up to 12 months post injury. Healthcare providers should emphasise dedicated family support services for paediatric trauma patients, focusing on their psychosocial needs and ensuring access to suitable resources. Paediatric nurses are a major part of this service and should contribute to future research, co-designing and implementing these improved family support services to better serve families affected by paediatric trauma. • Family Support Services can improve paediatric trauma recovery. • Quality of life and psychosocial improvements up to 12 months post-injury. • Emphasises the necessity for continuous, family-centred psychosocial support. • Future research must focus on tailored care and diverse family needs. [ABSTRACT FROM AUTHOR]

Moderate to severe traumatic brain injury (TBI) contributes to a significant burden across Australia. However, the data required to inform targeted equitable system‐level improvements in emergency TBI care do not exist. The incidence and determinants of outcomes following moderate to severe TBI in Australia remain unknown. The variation in the impact of moderate to severe TBI, according to patient demographics and injury mechanism, is poorly defined. The Australian Traumatic Brain Injury National Data Project will lead to a clear understanding, across Australia and pre‐specified subgroups (including Aboriginal and Torres Strait Islander peoples), of the incidence, determinants and impact of priority outcomes following moderate to severe TBI, including survival to discharge home. Furthermore, this project will establish a set of national clinical quality indicators for patients experiencing a moderate to severe TBI. The Australian Traumatic Brain Injury National Data Project will inform where to target emergency care system‐wide improvements. Without baseline data, efforts are wasted. [ABSTRACT FROM AUTHOR]

Injury is the leading cause of hospitalisation of children in Australia and can cause ongoing physical and psychological morbidity. Hospital staff provide excellent physical care to injured children, but there is a need for models of care that improve psychosocial care. To address this gap, a trauma support social work service was trialled at an Australian paediatric trauma hospital, to guide families of injured children through the healthcare system from the day of the child's injury to 6 months following discharge. A mixed methods approach was used to evaluate the service and used a range of data sources—trauma registry records, the Trauma Support Coordinator (TSC) journal, staff surveys, and interviews. Findings from this small study suggest the TSC was able to improve the coordination of care, provide information, and meet the emotional needs of families of injured children. Ways to improve the effectiveness and acceptance of the TSC role were also identified. IMPLICATIONS Injured children should be allocated a dedicated TSC for their entire stay in hospital to provide continuity of care for the child and their family. Situating the TSC role in the Emergency Department will allow for early contact with families when support is most crucial. Incorporation of the TSC role into the social work roster will reduce "doubling up" of psychosocial services offered to families. [ABSTRACT FROM AUTHOR]

Introduction: Injury is a leading cause of death and disability world-wide. Little is known about the day-to-day challenges the trauma clinicians face in their practice that they feel could be improved through an increased evidence base. This study explored and ranked the trauma clinical practice research priorities of trauma care professionals across Australia and New Zealand.Methods: A modified-Delphi study was conducted between September 2019 and January 2020. The study employed two rounds of online survey of trauma professionals from relevant Australia and New Zealand professional organisations using snowballing method. Participants were asked to rank the importance of 29 recommendations, each corresponding to a key challenge in trauma care delivery. Decisions on the priorities of the challenges were determined by a consensus of >70% of respondents ranking the challenge as important or very important.Results: One hundred and fifty-five participants completed Round One, and 106 participants completed Round Two. A total of 15 recommendations reached >70% in Round One. Nine recommendations also reached >70% consensus in Round Two. Recommendations ranked highest were 'Caring for elderly trauma patients', 'Identifying and validating key performance indicators for trauma system benchmarking and improvement', and 'Management of traumatic brain injury'.Conclusion: This study identified the priority areas for trauma research as determined by clinician ranking of the most important for informing and improving their practice. Addressing these areas generates potential to improve the quality and safety of trauma care in Australian and New Zealand. [ABSTRACT FROM AUTHOR]

Introduction: The availability and implementation of evidence-based care is essential to achieving safe, quality trauma patient outcomes. Little is documented, however, about the challenges trauma clinicians face in their day-to day practice, or their views on the availability of evidence. This paper presents the most significant clinical practice challenges reported by multidisciplinary trauma care professionals in Australia and New Zealand, in particular those that may be resolved with focussed research or enhanced implementation activity.Methods: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted between September 2018 and February 2019 using the Snowballing Method. Participants were recruited via a non-random sampling technique to complete an online survey. Thematic analyses were conducted.Results: There were nine significant clinical practice challenge themes in trauma care, arising from 287 individual clinical practice challenges reported. The most reported being clinical management (bleeding, spinal, older patients) and operationalisation of the trauma system. There was no consensus as to the availability of evidence to guide each theme.Conclusion: Future research should seek to address the clinical practice challenge of Australian and New Zealand trauma community to enable safe, quality trauma patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The Australia New Zealand Trauma Registry enables the collection and analysis of standardised data about trauma patients and their care for quality improvement, injury prevention and benchmarking. Little is known, however, about the needs of providers and clinicians in relation to these data, or their views on trauma quality improvement priorities. As clinical experts, trauma clinicians should have input to these as ultimately their practice may be influenced by report findings. This paper presents the perspectives of multidisciplinary trauma care professionals in Australia and New Zealand about the use of the Australia New Zealand Trauma Registry data and trauma quality improvement priorities.Methods: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted using the Snowballing Method between September 2018 and February 2019. Participants were recruited via a non-random sampling technique to complete an online survey. Descriptive statistical and content analyses were conducted.Results: The data use priorities identified by 102 trauma professionals from a range of locations participated were clinical improvement and system/process improvement (86.3%). Participants reported that access to trauma data should primarily be for clinicians (93.1%) and researchers (87.3%). Having a standardised approach to review trauma cases across hospitals was a priority in trauma quality improvement.Conclusion: Trauma registry data are under-utilised and their use to drive clinical improvement and system/process improvement is fundamental to trauma quality improvement in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Aim: Readmission of paediatric trauma patients is associated with increased hospital length of stay, additional operative procedures and significant costs to the health-care system. The rates and causes of readmission of paediatric trauma patients are not well reported outside of the USA or single centres. This nation-wide study is the first in Australia to examine the readmission rates, costs and characteristics of Australian paediatric trauma patients.Methods: This was a retrospective examination of linked hospitalisation and mortality data for injured children aged 16 or younger from 1 July 2001 to 30 June 2012, readmitted to hospital within 28 days of discharge. Data including injury severity, nature of injury, episodes of care and costs were extracted from hospitalisation data.Results: There were 37 603 injury children aged ≤16 years readmitted to hospital within 28 days during the 10-year period, a readmission rate of 5.5%. The most common principal injury requiring readmission was fracture (52.6%) and burns (19.3%). A total of 66% of all patients had a readmission diagnosis of injury, complication of their initial injury or complication of surgical and medical care; 30% were readmitted for a specific procedure or follow-up care. The total cost of readmissions was AU$108 million.Conclusions: Hospital readmission rates of paediatric trauma patients in Australia are due to injury or a complication of injury and are associated with significant costs. Early identification of at-risk patients and the prevention of complications are needed to prevent the ongoing burden of readmission. [ABSTRACT FROM AUTHOR]

Background: Efforts to improve teamwork in trauma include simulation-based team training with a non-technical skills (NTS) focus. However, there is a lack of evidence to inform the development of team training programs for maximum uptake of NTS in clinical practice. This descriptive paper aims to evaluate the extent NTS were practiced by the trauma team in a Level 1 trauma hospital after NTS training and to identify facilitators and barriers to use of NTS in clinical practice.Method: A 38-item questionnaire targeting clinicians who attended a simulation based multidisciplinary Trauma Team Training program was developed. The questionnaire was developed using the Theoretical Domains Framework, a validated tool to identify what practices need to change. It included questions on the current practice of NTS in real life trauma resuscitation.Results: Eighty six of 235 eligible participants (rate 37%) responded to the questionnaire. All relevant professions and clinical services were represented. There were 15 facilitators and 12 barriers identified. Barriers and facilitators were allocated to categories of factors known to influence trauma team practices. These were: (1) organisational factors that influence the trauma team, (2) team factors that influence teamwork and (3) cognitive factors that influence team decision making.Conclusion: NTS were being used by frontline clinicians in real world trauma resuscitations to varying degrees, depending on organisational, team and cognitive facilitators and barriers. Facilitators to the implementation of NTS skills during trauma emergencies included team composition, roles and responsibilities, procedural compliance and leadership. Barriers included decision making and communication. This study described team members experience of using NTS in 'real world trauma resuscitation' to inform future team training interventions. [ABSTRACT FROM AUTHOR]

Introduction: Injuries are a major cause of disability and lost productivity. The case for a national trauma registry has been recognized by the Australian Commission on Safety and Quality in Health Care and at a policy level. Background: The need was flagged in 1993 by the Royal Australasian College of Surgeons and the Australasian Trauma Society. In 2003, the Centre of National Research and Disability funded the Australian and New Zealand National Trauma Registry Consortium, which produced three consecutive annual reports. The bi‐national trauma minimum dataset was also developed during this time. Operations were suspended thereafter. Method: In response to sustained lobbying the Australian Trauma Quality Improvement Program including the Australian Trauma Registry (ATR) commenced in 2012, with data collection from 26 major trauma centres. An inaugural report was released in late 2014. Result The Federal Government provided funding in December 2016 enabling the work of the ATR to continue. Data are currently being collected for cases that meet inclusion criteria with dates of injury in the 2017–2018 financial year. Since implementation, the number of submitted records has been increased from fewer than 7000 per year to over 8000 as completeness has improved. Four reports have been released and are available to stakeholders. Conclusion: The commitment shown by the College, other organizations and individuals to the vision of a national trauma registry has been consistent since 1993. The ATR is now well placed to improve the care of injured people. [ABSTRACT FROM AUTHOR]

Introduction: Catastrophic haemorrhage is recognised as the leading cause of preventable death in trauma and is also prevalent in medical and other surgical aetiology. Prehospital blood product transfusion is increasingly available for both military and civilian emergency teams. Hospitals have well-established massive transfusion protocols for the resuscitation of this patient group, however the use and impact in the prehospital field is less understood.Aim: To identify and evaluate the current knowledge surrounding prehospital blood product administration for patients with catastrophic haemorrhage.Methods: The integrative review method included systematic searching of online databases Medline, EMBASE, SCOPUS and CINAHL alongside hand-searching for primary research articles published prior to 19 November 2018. Papers were included if the population studied patients with catastrophic haemorrhage who received prehospital transfusion of blood products. The level of evidence and quality was evaluated using the NHMRC hierarchy of evidence. All identified full text articles were reviewed by all authors.Results: Twenty-two papers were included in the final analysis, including both civilian (16) and military (6) practice. The earliest publication for prehospital transfusion was 1999, with increasing prevalence in recent years. Findings were extracted and into two main categories; (1) transfusion processes included team staffing, product selection, and criteria for transfusion and (2) transfusion outcomes; transfusion safety, haemoglobin, hospital intervention and mortality.Discussion: The level of evidence specific to prehospital blood product transfusion is low, with predominantly retrospective methods and rarely sufficient sample sizes to reach statistical significance. Prehospital research is challenged by clinical and logistical variability preventing accurate cohort matching, sample sizes and inconsistent data collection. Evaluation of prehospital transfusion in isolation is also particularly problematic as multiple factors and developments in clinical practice affect patient outcomes and all samples were subject to survival bias. Conclusion The volume and strength of the available evidence prevents accurate evaluation of the intervention and definitive practice recommendations however prehospital transfusion is shown to be logistically achievable and without serious incident. The reviewed evidence broadly supports the translation of recent in-hospital studies, such as PROMTT and PROPPR. Further research specific to prehospital practice is required to guide the development of evidence-based protocols. [ABSTRACT FROM AUTHOR]

Childhood injury is the largest cause of paediatric hospitalisation in Australia. Parents' psychological wellbeing is important in enabling them to support their children's recovery, however little is known about parents' psychosocial support needs during their child's admission to the emergency department. This study explores the experiences and support needs of parents of critically injured children in the emergency department. An exploratory qualitative approach was used. Semi-structured face to face interviews were conducted with 40 parents of 30 critically injured children aged 0–12 years across 4 Australian hospitals. Transcribed data were managed using NVivo 10 and qualitative content analysis was performed. Four themes of parent experience emerged from analysis: being in shock and distress; feeling challenged by the ed environment; dealing with urgent priorities; and having immediate needs met. There is a need for easy-to-understand information for parents in the ED following their child's injury. Recommendations include use of a checklist for emergency clinicians on what information to provide parents and provision of anticipatory guidance to parents on what to expect psychologically following injury. A dedicated family support coordinator is needed to support parents and children throughout the injury trajectory. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the pain management experiences of recently discharged adult trauma patients and the discharge practices of the treating hospital. Background: Adult trauma patients are not always able to manage their pain effectively and as a result often experience intense and enduring injury pain at home. They describe their pain experience as unique and debilitating, and report feeling uninformed at hospital discharge. There is a need to understand what is fundamentally required for this population at hospital discharge, to facilitate competent pain management and promote best possible outcomes. Design: A mixed methods convergent study design. Methods: The quantitative results (incidence, intensity and impact of injury pain and the barriers to effective pain management) were merged with the qualitative results (patient experiences and beliefs) to produce greater understanding about the reasons behind the pain management practices of participants. Results: Integration of the quantitative and qualitative data produced four new themes. These themes demonstrate that recently discharged adult trauma patients do not have the knowledge or experience to understand or manage their injury pain effectively at home. Inadequate information and education by clinicians, at hospital discharge, contribute to this insufficiency. Conclusions: Clinicians need to understand the trauma patient pain experience to appreciate the importance of their discharge practices. Increased understanding and implementation of evidence‐informed discharge processes would improve current discharge practices and ultimately support and improve the trauma patient's injury pain management practices at home. Relevance to clinical practice: By understanding the patient perspective in the pain management of injuries, clinicians are better able to appreciate what hospital discharge practices and information are genuinely required by the trauma patient to manage their pain effectively at home, potentially preventing the long‐term consequences of injury pain. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify barriers to adherence with prescribed analgesic regimens in recently discharged trauma patients. Background Trauma pain severely interferes with the life of healthy and often working individuals with intense and enduring pain experienced at home following discharge. The reasons for this are unclear considering discharge information (including discharge referral letters and nursing discharge checklists) and analgesics (scripts and/or medication) are routinely provided to patients at hospital discharge. Design A prospective exploratory study. Methods Between July-December 2014, 82 recently discharged adult trauma patients completed a questionnaire about their injury-related pain and pain management experiences posthospital discharge from a level one trauma centre. For 77 of these participants, medical records were reviewed for documentation regarding pain, analgesic consumption and hospital discharge processes. Results Sixty-five participants (84%) consumed opioids prior to discharge, with two-thirds (65%) of these participants given a script for and/or opioid medication at hospital discharge. Of the 77 participants who took analgesics following discharge, 26 (34%) indicated they had experienced side effects and 16 (21%) used pain medication not prescribed by a doctor. Whilst it was documented that discharge letters were given to 25 participants (32%) at discharge and 13 participants (17%) had completed nursing discharge checklists, these participants reported the lowest pain severity and interference scores postdischarge. Conclusions Insufficient information and analgesics given to trauma patients at hospital discharge and inconsistent and incomplete discharge processes fail to equip trauma patients to effectively manage their pain at home. Relevance to clinical practice It is crucial that nurses and other healthcare professionals are aware of and actively contribute to correct and complete discharge processes. Effective patient and hospital facilitators can contribute to good pain management practices amongst recently discharged trauma patients, which will thereby improve the functional outcomes of this patient population. [ABSTRACT FROM AUTHOR]

Objective Anticoagulant and antiplatelet ( ACAP) drugs are associated with increased mortality in trauma patients, therefore medication history on admission is important. Whether these medications are recorded on trauma admission has not been investigated, nor if absence of a medication history is associated with worse patient outcomes. Methods We conducted a retrospective database review combining demographic and outcome data from the St George Hospital (Sydney) trauma registry with admission medication history in the electronic record. To contrast medications with a known increased risk ( ACAP) to patients with unknown risk, patients were divided into three groups: those on ACAPs, no- ACAP if medication history was present and no- ACAP documented, or no-Hx if no medication history recorded. Inclusion criteria were aged >16 and Injury Severity Score ( ISS) >12. Admission demographic data and outcome data were compared between all three groups. Results Of 533 consecutive patients, 21% comprised the no-Hx group, while 22% were on an ACAP and 57% not on an ACAP. No-Hx patients had more severe head injuries and a younger median age compared to ACAP patients (42 vs 82 years old, P < 0.001). Mortality was higher for ACAP (24%; 95% CI 17-33%) compared to no- ACAP (11%; 95% CI 8-16%) or no-Hx patients (12%; 95% CI 7-20%) ( P = 0.04). Conclusions While a large number of severe trauma patients were admitted without a medication history, no-Hx patients did not appear at increased risk of adverse outcomes. ACAP patients had a higher mortality compared to no- ACAP highlighting the vulnerability of this group. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the importance of, and methods for, successfully conducting and translating research into clinical practice. Background There is universal acknowledgement that the clinical care provided to individuals should be informed on the best available evidence. Knowledge and evidence derived from robust scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care. Translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. Despite its importance, translating research into clinical practice is challenging. There are more nurses in the frontline of health care than any other healthcare profession. As such, nurse-led research is increasingly recognised as a critical pathway to practical and effective ways of improving patient outcomes. However, there are well-established barriers to the conduct and translation of research evidence into practice. Design This clinical practice discussion paper interprets the knowledge translation literature for clinicians interested in translating research into practice. Methods This paper is informed by the scientific literature around knowledge translation, implementation science and clinician behaviour change, and presented from the nurse clinician perspective. We provide practical, evidence-informed suggestions to overcome the barriers and facilitate enablers of knowledge translation. Examples of nurse-led research incorporating the principles of knowledge translation in their study design that have resulted in improvements in patient outcomes are presented in conjunction with supporting evidence. Conclusions Translation should be considered in research design, including the end users and an evaluation of the research implementation. The success of research implementation in health care is dependent on clinician/consumer behaviour change and it is critical that implementation strategy includes this. Relevance to practice Translating best research evidence can make for a more transparent and sustainable healthcare service, to which nurses are central. [ABSTRACT FROM AUTHOR]

Background A previous report from the New South Wales (NSW) Trauma Registry identified falls and increasing age of severely injured patients as highly prevalent, but detailed injury and demographic profiles, outcomes and their predictors are poorly reported. This study describes the fall-injury profile in the older adult major trauma patient in NSW. Methods A retrospective registry based study between 2010 and 2014 on patients aged 55 years and over who sustained a moderate to critical injury from a fall, examining mortality and length of stay using regression analyses. Results There were 4263 major trauma falls between 2010 and 2014, most occurring at home (55.4%), on the same level (46.7%) and resulting in head injury (63.2%). Significant predictors for mortality following a fall were increased age, male gender, falls in residential care institutions, isolated head injuries and injury classified as critical (ISS 41–75). Conclusions The outcomes of falls in the older adult are very poor and a focused prospective study is required to identify areas for intervention and prevention. The predictors of mortality following a fall identified in this study can be used with existing research to develop tools and design care pathways for implementation in the emergency context to improve patient care and outcomes. [ABSTRACT FROM AUTHOR]

Background: Being the parent of a severely injured child involves many stressors throughout the trauma journey. Internationally, little is known about the experiences or levels of emotional distress, parenting stress, quality of life, and resilience for parents of injured children. The aim of this study is to investigate the experiences, unmet needs and outcomes of parents of physically injured children 0-12 years over the 2 year period following injury.Methods/design: This is a prospective longitudinal study using an embedded mixed methods design. This design has a primary qualitative strand which incorporates supplementary quantitative data on child quality of life, and parental quality of life, parenting stress, emotional distress, and resilience at four time points; the acute hospitalisation phase, and at 6, 12 and 24 months following injury. The primary sample are parents of injured children 0-12 years hospitalised in the Australian states of New South Wales, Queensland, Victoria and South Australia. Primary data sources are child and parent demographic data; survey data; and semi-structured interview data across a 24 month period.Discussion: This study aims to address the existing gap in knowledge on the experiences and unmet support needs of parents in the 2 years following child injury to provide guidance for care provision for these families. There is a lack of evidence-based recommendations for supporting parents and families of injured children and strengthening their capacity to address the challenges they face. [ABSTRACT FROM AUTHOR]

The article discusses the trauma eLearning module developed for trauma patient management in the ward environment using adult learning principles, and evaluated for self-efficacy of nurses, module relevance and usability, and application of knowledge. Topics discussed include the self-efficacy questionnaire, usability of eLearning module evaluated by participants immediately upon module completion, and questionnaire assess application of module content to clinical practice.

Background Effective assessment and resuscitation of trauma patients requires an organised, multidisciplinary team. Literature evaluating leadership roles of nurses in trauma resuscitation and their effect on team performance is scarce. Aim To assess the effect of allocating the most senior nurse as team leader of trauma patient assessment and resuscitation on communication, documentation and perceptions of leadership within an Australian emergency department. Methods The study design was a pre-post-test survey of emergency nursing staff (working at resuscitation room level) perceptions of leadership, communication, and documentation before and after the implementation of a nurse leader role. Patient records were audited focussing on initial resuscitation assessment, treatment, and nursing clinical entry. Descriptive statistical analyses were performed. Results Communication trended towards improvement. All (100%) respondents post-test stated they had a good to excellent understanding of their role, compared to 93.2% pre-study. A decrease (58.1–12.5%) in ‘intimidating personality’ as a negative aspect of communication. Nursing leadership had a 6.7% increase in the proportion of those who reported nursing leadership to be good to excellent. Accuracy of clinical documentation improved ( P  = 0.025). Conclusion Trauma nurse team leaders improve some aspects of communication and leadership. Development of trauma nurse leaders should be encouraged within trauma team training programmes. [ABSTRACT FROM AUTHOR]

Aims To Describe injury profile and costs of older person trauma in New South Wales; quantify variations with peer group costs; and identify predictors of higher costs. Methods Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥55 years) during 2008-2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses. Results Six thousand two hundred and eighty-nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1-3: $3405-13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs. Conclusion Older person trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding. [ABSTRACT FROM AUTHOR]

Introduction The Australasian Trauma Verification Program was developed in 2000 to improve the quality of care provided at services in Australia and New Zealand. The programme outlines resources required for differing levels of trauma services. This study compares the human resources in Australia and New Zealand trauma services with those recommended by the Australasian College of Surgeons Trauma Verification Program. Methods In September 2011, all trauma nurse coordinators in Australia and New Zealand were invited to participate in an electronic survey endorsed by the Australasian Trauma Society. This study expands on previous bi-national research and aimed to identify demographic and trauma service human resource levels. Results Fifty-three surveys (78%) were completed and all 27 Level 1 trauma centres represented. Of the Level 1 trauma centres, a trauma director and fellow were available at 16 (51.8%) and 14 (40.7%) centres, respectively. The majority (93%) had a full-time trauma coordinator although a trauma case manager was only available at 14 (48.1%) of Level 1 trauma centres. Despite the large amount of data collection and extraction required, trauma services had limited access to a data manager (50.9%) or clerical staff (36.9%). Conclusion Human resources in Australian and NZ trauma services are not reflective of those recommended by the Australasian Trauma Verification Program. This impacts on the ability to coordinate trauma monitoring and performance improvement. Review of the Australasian Trauma Verification Model Resource Criteria is required. Injury surveillance in Australia and NZ is hampered by insufficient trauma registry resources. [ABSTRACT FROM AUTHOR]

Abstract: Background: Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. Aim: To describe the costs of acute trauma admissions in trauma centres, identify predictors of higher treatment costs and cost variance in New South Wales (NSW), Australia. Materials and methods: Data linkage of admitted trauma patient and financial data provided by 12 Level 1 NSW trauma centres for the 08/09 financial year was performed. Demographic, injury details and injury scores were obtained from trauma registries. Individual patient general ledger costs (actual trauma patient costs), Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs (which form the basis of funding) were obtained. The actual costs incurred by the hospital were then compared with the state-wide AR-DRG average costs. Multivariable multiple linear regression was used for identifying predictors of costs. Results: There were 17,522 patients, the average per patient cost was $10,603 and the median was $4628 (interquartile range: $2179–10,148). The actual costs incurred by trauma centres were on average $134 per bed day above AR-DRG costs-determined costs. Falls, road trauma and violence were the highest causes of total cost. Motor cyclists and pedestrians had higher median costs than motor vehicle occupants. As a result of greater numbers, patients with minor injury had comparable total costs with those generated by patients with severe injury. However the median cost of severely injured patients was nearly four times greater. The count of body regions injured, sex, length of stay, serious traumatic brain injury and admission to the Intensive Care Unit were significantly associated with increased costs (p <0.001). Conclusion: This multicentre trauma costing study demonstrated the feasibility of trauma registry and financial data linkage. Discrepancies between the observed costs of care in these 12 trauma centres and the NSW average AR-DRG costs suggest that trauma care is currently underfunded in NSW. [Copyright &y& Elsevier]

Aims To describe the costs of acute trauma admissions for children aged ≤15 years in trauma centres; to identify predictors of higher treatment costs and quantify differences in actual and state-wide average cost in New South Wales (NSW), Australia. Method Admitted trauma patient data provided by 12 trauma centres was linked with financial data for 2008-2009. Demographic, injury details and injury severity scores (ISS) were obtained from trauma registries. Individual patient costs, Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs were obtained. Actual costs incurred by each hospital were compared with state-wide AR-DRG average costs. Multivariate multiple linear regression identified predictors of cost. Results There were 3493 patients with a total cost of AUD$20.2 million. Falls (AUD$6.7 million) and road trauma (AUD$4.4 million) had the highest total expenditure. The reduction in cost between ISS < 9 compared to ISS 9-12 and ISS > 12 was significant ( P < 0.0001). The median cost of injury increased with every additional body region injured ( P < 0.0001). For each additional day spent in hospital, there was an increased cost of AUD$1898 and patients admitted to an intensive care unit (ICU) cost AUD$7358 more than patients not admitted to ICU. The total costs incurred by trauma centres were AUD$1.4 million above the NSW peer group average cost estimates. Conclusions The high financial cost of paediatric patient treatment highlights the need to ensure prevention remains a priority in Australia. Hospitals tasked with providing trauma care should be appropriately funded and future funding models should consider trauma severity. [ABSTRACT FROM AUTHOR]

Abstract: Paediatric trauma centres seek to optimise the care of injured children. Trends in state-wide paediatric care and outcomes have not been examined in detail in Australia. This study examines temporal trends in paediatric trauma outcomes and factors influencing survival and length of stay. A retrospective review was conducted using data from the NSW Trauma Registry during 2003–2008 for children aged 15 years and younger who were severely injured (injury severity score>15). To examine trauma outcomes descriptive statistics and multivariable logistic and linear regression were conducted. There were 1138 children severely injured. Two-thirds were male. Road trauma and falls were the most common injury mechanisms and over one-third of incidents occurred in the home. Forty-eight percent of violence-related injuries were experienced by infants aged less than 1 year. For the majority of children definitive care was provided at a paediatric trauma centre, but less than one-third of children were taken directly to a paediatric trauma centre post-injury. Children who received definitive treatment at a paediatric trauma centre had between 3 and 6 times higher odds of having a survival advantage than if treated at an adult trauma centre. The number of severe injury presentations to the 14 major trauma centres in NSW remains constant. It is possible that injury prevention measures are having a limited effect on severe injury in NSW. This research provides stimulus for change in the provision and co-ordination in the delivery of trauma care for injured children. [Copyright &y& Elsevier]

Predominantly, males have a higher risk of injury mortality and morbidity than females. However, less is known about gender differences for injury and trauma outcome at a regional level. The aim of this study was to examine the epidemiologic profile and trauma outcomes of males and females at a level 1 trauma center to inform local injury prevention efforts. A retrospective review was conducted of injuries identified from the trauma registry of the New South Wales St George Public Hospital during January 1, 2004, to December 31, 2008. There were 6763 major trauma presentations, and 65.1% of these were of males. Males had a higher proportion of trauma presentations in each age group, except for those younger than 15 years, 45 to 54 years, and older than 65 years. Almost all presentations were as a result of unintentional injuries. However, 8% of males were victims of assault compared with 2% of females. Males were more likely to be injured while working and during leisure or sports activities and at sporting, farming, home, trade, and industrial locations than females. Males were more likely to be more severely injured than females and generally had a longer hospital length of stay. There was no significant difference in the rate of mortality between the genders. There are distinct differences between the sexes regarding the mechanism and severity of injury and trauma outcomes. Local injury prevention initiatives should be targeted to address gender differences. Future social research should examine the interplay of the construction of masculinities with male injury. [ABSTRACT FROM AUTHOR]

Summary: Injury is a leading cause of mortality, hospitalised morbidity and disability in Australia and New Zealand. Of the many public health challenges facing clinicians on a daily basis, traumatic injury is one of the most significant. A large spectrum of injury severity may result, ranging from minor injuries which require little medical intervention through to severe multisystem trauma, requiring definitive management by an experienced multidisciplinary team. An improved understanding of the incidence and prevalence of trauma can empower clinicians of all levels of experience to contribute to improving the trauma system they work in at a local level. This paper provides an overview of the history and epidemiology of traumatic injury in Australia and New Zealand. The reading of this article and completion of revision questions is equivalent to 2h of self-directed learning. [Copyright &y& Elsevier]

Summary: Background: Gunshot wounds are responsible for considerable damage to the body and its structures. Between 1995 and 2005, Gunshot wounds were the second most common cause of murders in NSW, although in comparison to other countries, are uncommon in Australia. However, they do produce high velocity injuries and are associated with numerous potential complications including bony, vascular and nerve injuries, soft tissue destruction, compartment syndrome, delayed wound healing, potential for infection and, a number of psycho-social complications. Methods: The following paper is a case study based on a de-identified patient who presented following a gunshot injury, focussing on neurovascular assessment and communication. Results: This case study generates numerous discussion points including pre-hospital notification, efficient in-hospital trauma team response, effective primary and secondary surveys, intravenous fluid use in penetrating injuries, regular nursing observations and methods for neurovascular assessment, potential causes of vascular compromise in limb injuries, communication and assertiveness, analgesia, and forensic considerations in the emergency department. Conclusion: The importance of neurovascular observations cannot be understated and must be effectively conducted and reported upon in a timely manner when results are not within the normal parameters. Further, patient advocacy and effective inter-disciplinary communication is essential to ensure the patient is provided with a recovery that is uncomplicated and with as minimal morbidities as possible. [Copyright &y& Elsevier]

Injury among older persons is well recognized as a growing problem. We reviewed our level-1 trauma center trauma registry finding that the most frequent presentations among people aged older than 65 years were due to falls and motor vehicle crashes. We surveyed participants at two of our older person injury awareness seminars to identify risk factors. Participants at our out-reach programme have several injury risk factors including polypharmacy for which our programme content has been tailored. We discuss this in relation to the older person injury-prevention literature. Because implementing our out-reach seminars, older person trauma presentations to our trauma center have decreased slightly. [ABSTRACT FROM AUTHOR]

The use of Diagnosis Related Groups (DRGs) may not be an accurate tool to provide reimbursement for trauma services. This study aimed to determine whether Australian Refi ned Diagnosis Related Groups (AR-DRGs) adequately describe the trauma patient episode and to identify AR-DRG groupings where reimbursement was not commensurate with actual cost. The AR-DRG allocated costs and actual costs of a sample of 206 trauma patient episodes were reviewed during a three-month period. Of the AR-DRG groups identified in the patient episodes, 62.8% were not commensurate with actual cost incurred, equating to an overall loss of $113,921 from under-funded acute trauma patient episodes over a three-month period. Assault-related penetrating trauma, traffi c-related and sport-related incidents were all inadequately reimbursed using AR-DRGs compared with the actual cost of treatment. Cases involving female patients, patients aged 45 years or less and those with moderate injuries were similarly underfunded. AR-DRGs are not adequate to describe the extent of injuries experienced by trauma patients and there is a need to investigate alternative funding models for trauma services. [ABSTRACT FROM AUTHOR]

Summary: Background: The Trauma Redesign Team sought to examine, and where required redesign, the trauma patient journey and trauma team process within the Emergency Department (ED) at Westmead Hospital, a Level 1 Trauma Centre. This initiative was born from the perceived growing disharmony between professions and services involved in the resuscitation and treatment of trauma patients. The aim of the project was to improve the staff experience and the patient journey within the ED. Method: By adopting Redesign methodology, the ‘as is’ state was identified using a multidisciplinary approach to develop and examine detailed process maps of the trauma patient journey and the staff roles within the trauma team. Patient, family and staff interviews were also conducted to develop a detailed review of the process. Data obtained from these activities were analysed and grouped into themes enabling prioritisation for review and implementation. Outcome: The process of Trauma Redesign delineated many features of the ‘trauma team’ at Westmead Hospital which were either redundant, non value adding or affecting the cohesion and function of the team. Five predominant themes were identified and targeted for solution development planning and sustainable change, with a focus on patient safety and feasibility. Conclusion: Redesign is a complex, inclusive and detailed process that has effectively, comprehensively and clearly highlighted areas of need in the trauma process. This has been an invaluable experience for staff and patients and highly recommended for those considering reviewing their departmental practices and systems. [Copyright &y& Elsevier]

Abstract: Background: Appropriate triage of the trauma patient is essential to ensure prompt access to definitive care. Many trauma centres use a “tiered” trauma call protocol with the intention of providing a match between the facility''s resources and the needs of the patient. This study describes the incidence and impact of undertriage on the trauma patient in the context of an Australian level 1 trauma centre with a tiered trauma call system. Methods: This was a retrospective analysis of prospective data collected through the Trauma Registry. Undertriage was defined as sustaining an injury severity score greater than 15 and receiving a non-optimal response (i.e., trauma standby call or no call). The level of association between outcome measures (such as LOS in ED, time to OT) and the level of trauma call the patient received was assessed using a general linear model, controlling for injury severity and haemodynamic stability. Results: Between February 2004 and November 2008, 5233 patients meeting trauma criteria presented to the study hospital. There was an undertriage rate of 42% and overtriage rate of 21%. Patients were more likely to be undertriaged if they were older, self-presented, their cause of injury was assault or their head or chest were their most severely injured body region. Undertriaged patients had a significantly longer LOS in the ED (2h) than appropriately triaged patients. Conclusion: The implementation of a tiered trauma call system resulted in significant undertriage, especially if the patient was older, had been assaulted or had a head/chest injury. Undertriaged patients experienced delay to definitive care. This study has highlighted the importance of compliance with trauma team activation criteria, trauma monitoring and evaluation. [Copyright &y& Elsevier]

Summary: Blunt cardiac injury typically occurs in patients who are severely injured and have sustained significant thoracic trauma such as multiple rib fractures, pulmonary contusions and haemopneumothorax. Blunt cardiac injury while uncommon can have life threatening consequences. Often no clinical features manifest until a complication occurs which can be quite sudden. We describe the screening methods for blunt cardiac injury (most importantly the ECG), and discuss evaluation is focused on identifying those likely to develop cardiac complications, so they can be closely monitored and intervention rapidly performed. This case has highlighted the value of pro-active nursing care to detect physiologic alteration and deter further deterioration. The evidence surrounding early investigations such as electrocardiography and cardiac troponin measurement have been discussed in clinical context. The importance of ongoing monitoring, awareness of signs of deterioration and effective communication has been highlighted. [Copyright &y& Elsevier]

Previous parts to this series on thoracic and neck trauma discussed the anatomy and physiology of the thorax, assessment and initial nursing interventions, imaging and adjuncts to diagnosis. Part 2 described specific chest wall and lung injuries, types of pneumothoraces and their diagnosis and management. Section 3 examined other types of thoracic injuries and their management, such as trauma to the diaphragm and heart. This final part provides a brief but concise overview of neck anatomy, trauma and management. [Copyright &y& Elsevier]

Aim: To examine fall-related hospitalised morbidity in New South Wales (NSW) and to describe the pattern of fall-related major trauma presentations at a Level 1 Trauma Centre in NSW for younger and older fallers. Methods: Fall-related injuries were identified in the NSW Admitted Patients Data Collection during 1 July 1999–30 June 2008 and the trauma registry of the NSW St George Public Hospital during 1 January 2006–6 December 2008. Results: There were 434 138 hospitalisations and 862 fall-related trauma presentations. Older fallers had a higher incidence of hospitalisation, being more likely to fall on the same level during general activities at home, injuring their hip or thigh. Older fallers were also more likely to have an Injury Severity Score > 9, undergo physiotherapy and stay in hospital for >1 day than younger fallers. Conclusion: Falls, particularly for older individuals, are an important cause of serious injury, representing a considerable burden in terms of hospitalised morbidity. [ABSTRACT FROM AUTHOR]

Previous parts to this series on thoracic and neck trauma discussed the anatomy and physiology of the thorax, assessment and initial nursing interventions, imaging and adjuncts to diagnosis. Part 2 describes specific chest wall and lung injuries, types of pneumothoraces and their diagnosis and management. This section, part 3 of 4, discusses other types of thoracic injuries and their management, such as trauma to the diaphragm and heart. [Copyright &y& Elsevier]

Summary: Dental first aid is both simple and inexpensive and can dramatically improve future dental outcomes; however, it is rarely appropriately provided. We provide a simple guide with instructions and images and links to further resources. [Copyright &y& Elsevier]

Abstract: This is the first of a four part series discussing thoracic trauma. Part one discusses the anatomy and physiology of the thorax, assessment and initial nursing interventions, imaging and adjuncts to diagnosis. Part 2 describes specific chest wall and lung injuries, types of pneumothoraces and their diagnosis and management. Section 3 examined other types of thoracic injuries and their management, such as trauma to the diaphragm and heart. The final part provides a brief but concise overview of neck anatomy, trauma and management. [Copyright &y& Elsevier]

Abstract: Background: Regionalised trauma systems have been shown to improve the outcome of seriously injured patients. However, it is not clear which components of these systems have the most impact on patient outcomes. The study evaluates the association between implementation of a single, dedicated trauma admitting service at an urban trauma centre and subsequent patient outcomes. Methods: This was a retrospective review of prospectively collected trauma registry data at the St George Public Hospital, a level I urban trauma centre in Sydney, Australia. Two concurrent 18-month periods, before and after implementation of a full-time trauma service, were compared for differences in patient mortality, complication rates, and ED, ICU and hospital lengths of stay. Results: There were 962 patients admitted to the hospital in the 18 months immediately preceding the implementation of the trauma service (the PRE group) and 990 patients in the subsequent 18 months (the POST group). There were no significant differences between groups with respect to patient demographics or mechanism of injury, although a higher proportion of patients in the POST group had injury severity scores (ISS) above 15 (30.6% versus 24.8%, p =0.02). There was an 8% reduction in death rate among the most severely injured patients (ISS>15), in the POST group as compared to the PRE group (12.2% and 20.2% respectively, p =0.007). Conclusions: The implementation of a full-time trauma service in this hospital was associated with a reduction in death rate among the most severely injured patients, and a decrease in LOS in patients with an ISS<15. [Copyright &y& Elsevier]

Summary: Trauma patient care is universally recognized as extremely time and resource intensive yet the trauma nursing case management model has yet to be thoroughly embraced in Australian trauma care. Trauma case management (TCM) is a nursing model that involves a nurse with expertise in trauma overseeing and coordinating trauma patient care. The goals of TCM are to provide well-coordinated care for patients and families and ensure that satisfactory clinical outcomes are met. The St. George Hospital Trauma Service first implemented a TCM program in August 2000, since then, we have been able to document improvement in many aspects of trauma care. This paper describes problems commonly encountered when providing care for trauma patients and an experiential description of “The day in the life of a trauma case manager.” [Copyright &y& Elsevier]

Introduction: Injury is a major global health burden. Trauma registries have been used for decades to monitor the burden of injury and inform trauma care. However, the extent to which trauma registries have fulfilled their potential remains uncertain. The aims of this study were to determine the current and priority uses of trauma registries across Australia and New Zealand and to establish the priority clinical outcomes, the probability for which, if known for an individual trauma patient, would better inform that same patient's care, during hospital admission.Methods: A prospective observational study using survey methodology was conducted. Participants were sourced from the Australia New Zealand Trauma Registry (ATR) participating hospitals. The survey questions included: the current uses and priorities for both single-site trauma registries and the binational trauma registry; the five top-ranked priority outcomes for which knowing the probability, for an individual patient, would inform care; and the priority timepoints for applying patient-level outcome prediction models.Results: Of the 26 ATR-participating hospitals, 25 were represented by a total of 54 participants in the survey, including trauma service directors and trauma nurse coordinators. The main trauma registry use and priority for the single site registries was to inform the quality improvement program; for the ATR, the main use was periodic reporting and the main priority was benchmarking. For each potential purpose of the registry, the future priority level was ranked more highly than the current level of utilisation. The most highly ranked priority patient-level outcomes requiring prediction were: preventable death, missed injury, quality of life, admission costs, pulmonary embolism, post-traumatic stress disorder, length of hospital stay, errors in decision-making and deep venous thrombosis. The time period between leaving the emergency department and the 24 h mark following presentation was considered the preferred time for patient-level priority outcome prediction.Conclusion: There is a mismatch between current trauma registry uses and future priorities. The priority outcomes demanding prediction in the first 24 h of a trauma patient's stay are preventable death, missed injury, quality of life, hospital costs, thromboembolism, post-traumatic stress disorder, length of hospital stay and errors in clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: Adult injury severity metrics are often applied to paediatric populations despite differences in anatomy, physiological and mortality risk. Measures to assess paediatric mortality have not been conducted on a population-wide basis.Purpose: To determine the predictive ability of the International Classification of Injury Severity Score (ICISS) in assessing 30-day mortality in a paediatric population, and to examine temporal trends for serious injury for common paediatric injury mechanisms.Methods: A retrospective analysis of linked injury hospitalisation and mortality data of children aged ≤16 years during 1 July 2002 to 30 June 2012 in Australia was conducted. Both multiplicative-injury and single-worst-injury ICISS were calculated. Logistic regression examined 30-day mortality with a range of predictor variables. The models were assessed in terms of their ability to discriminate survivors and non-survivors, model fit, and ability to explain outcome variance.Results: There were 728,584 index injury admissions and 1,064 (0.15%) deaths within 30-days of hospital admission. The multiplicative-injury ICISS was identified as a better predictor of 30-day mortality than the single worst-injury ICISS; and the best model included age group, gender, all comorbidities, trauma centre type, injury mechanism, and nature of injury as covariates. Temporal trends for serious injury have remained relatively constant over the 10-year period. Examination of specific injury mechanisms showed a significant decline in road trauma and drowning hospitalisations. In comparison, hospitalisations due to fall and self-harm injuries within adolescents increased.Conclusion: ICISS was shown to be excellent indicator for predicting 30-day mortality for all paediatric hospital admissions within a national jurisdiction. The rate of paediatric hospitalisation due to all-cause serious injury has not changed over a 10-year period despite being a national public health area of high priority. [ABSTRACT FROM AUTHOR]

Introduction: Pain following injury is often intense, prolonged and debilitating. If poorly managed, this acute pain has the potential to delay rehabilitation and lead to chronic pain. Recent quantitative Australian research recommends implementing further information and interventions to improve trauma patient outcomes, however, to ensure effectiveness, exploration of the patient perspective is imperative to ensure the success of future pain management strategies. This study aimed to gain understanding about the experience of pain management using prescribed analgesic regimens of recently discharged adult trauma patients.Method: Semi-structured interviews were used to explore the experiences and understandings of trauma patients in managing pain using prescribed analgesic regimens during the initial post-hospital discharge period. Twelve participants were purposively selected over a 6-month period at a level one trauma outpatient clinic based on questionnaire responses indicating pain related concerns. Qualitative data were thematically analysed.Results: The overarching finding was that injuries and inadequate pain management incapacitate the patient at home. Four main themes were developed: injury pain is unique and debilitating; patients are uninformed at hospital discharge; patients have low confidence with pain management at home; and patients make independent decisions about pain management. Patients felt they were not given adequate information at hospital discharge to support them to make effective decisions about their pain management practices at home.Conclusion: There is a need for more inclusive and improved hospital discharge processes that includes patient and family education around pain management following injury. To achieve this, clinician education, support and training is essential. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To investigate the state of knowledge on the relationship between physical trauma and mental health in patients admitted to hospital with traumatic physical injury. Background: Adults who sustain traumatic physical injury can experience a range of mental health problems related to the injury and subsequent changes in physical health and function. However early screening and identification of mental health problems after traumatic physical injury is inconsistent and not routine during the hospital admission process for the physically injured patient. Methods: Integrative review methods were used. Data were sourced for the period 1995–2010 from EMBASE, CINAHL, MEDLINE and PsycINFO and hand searching of key references. Abstracts were screened by 3 researchers against inclusion/exclusion criteria. Forty-one papers met the inclusion criteria. Data were retrieved, appraised for quality, analysed, and synthesised into 5 main categories. Results: Forty-one primary research papers on the relationship between mental health and traumatic physical injury were reviewed. Studies showed that post-traumatic stress disorder, depression and anxiety were frequent sequelae associated with traumatic physical injury. However, these conditions were poorly identified and treated in the acute hospital phase despite their effect on physical health. Conclusion: There is limited understanding of the experience of traumatic physical injury, particularly in relation to mental health. Greater translation of research findings to practice is needed in order to promote routine screening, early identification and referral to treatment for mental health problems in this patient group. [Copyright &y& Elsevier]

Abstract: Introduction: Information from hospital trauma registries is increasingly being used to support injury surveillance efforts. This research examines the potential of using trauma registry data for road traffic injury surveillance for different types of road users in terms of both the information collected and how representative trauma data are compared to two population-based road traffic injury data collections. Methods: The three data collections were assessed against recommended variables to be collected for injury surveillance purposes and the representativeness of the distribution of road traffic-related injury data from the trauma registry was compared to hospital admission and road traffic authority data collections. Results: Data from the trauma registry was largely not representative of the distribution of age groups or activities compared to the two population-based collections, but was representative for gender for some road user groups to at least one population-based data collection. Conclusions: Trauma data could be used to supplement information from population-based data collections to inform road safety efforts. Impact on Industry: Road safety policy makers should be aware of the potential and the limitations of using trauma registry data for road traffic injury surveillance. [Copyright &y& Elsevier]

Introduction: To provide effective care and promote wellbeing and positive outcomes for parents and families following paediatric critical injury there is a need to understand parent experiences and psychosocial support needs. This study explores parent experiences two years following their child's critical injury.Methods: This multi-centre study used an interpretive qualitative design. Parent participants were recruited from four paediatric hospitals in Australia. Semi-structured interviews were audio recorded and transcribed verbatim. Qualitative data were thematically analysed and managed using NVivo 11.Results: Twenty-two parents participated. Three themes were identified through analysis: Recovering from child injury; Managing the emotional impact of child injury; Being resilient and finding ways to adapt.Conclusions: A long-term dedicated trauma family support role is required to ensure continuity of care, integration of support and early targeted intervention to prevent long-term adverse outcomes for critically injured children and their families. Early and ongoing psychosocial intervention would help strengthen parental adaptation and address families' psychosocial support needs following child injury. [ABSTRACT FROM AUTHOR]

Background: Blunt chest injuries (BCI) are associated with high rates of morbidity and mortality. There are many interventions for BCI which may be able to be combined as a care bundle for improved and more consistent outcomes.Objective: To review and integrate the BCI management interventions to inform the development of a BCI care bundle.Methods: A structured search of the literature was conducted to identify studies evaluating interventions for patients with BCI. Databases MEDLINE, CINAHL, PubMed and Scopus were searched from 1990-April 2017. A two-step data extraction process was conducted using pre-defined data fields, including research quality indicators. Each study was appraised using a quality assessment tool, scored for level of evidence, then data collated into categories. Interventions were also assessed using the APEASE criteria then integrated to develop a BCI care bundle.Results: Eighty-one articles were included in the final analysis. Interventions that improved BCI outcomes were grouped into three categories; respiratory intervention, analgesia and surgical intervention. Respiratory interventions included continuous positive airway pressure and high flow nasal oxygen. Analgesia interventions included regular multi-modal analgesia and paravertebral or epidural analgesia. Surgical fixation was supported for use in moderate to severe rib fractures/BCI. Interventions supported by evidence and that met APEASE criteria were combined into a BCI care bundle with four components: respiratory adjuncts, analgesia, complication prevention, and surgical fixation.Conclusions: The key components of a BCI care bundle are respiratory support, analgesia, complication prevention including chest physiotherapy and surgical fixation. [ABSTRACT FROM AUTHOR]

Introduction: Physical injury is a leading cause of death and disability among children worldwide and the largest cause of paediatric hospital admission. Parents of critically injured children are at increased risk of developing mental and emotional distress in the aftermath of child injury. In the Australian context, there is limited evidence on parent experiences of child injury and hospitalisation, and minimal understanding of their support needs. The aim of this investigation was to explore parents' experiences of having a critically injured child during the acute hospitalisation phase of injury, and to determine their support needs during this time.Methods: This multi-centre study forms part of a larger longitudinal mixed methods study investigating the experiences, unmet needs and well-being of parents of critically injured children over the two-year period following injury. This paper describes parents' experiences of having a child 0-13 years hospitalised with critical injury in one of four Australian paediatric hospitals. Semi-structured interviews were conducted with forty parents and transcribed verbatim. The data were managed using NVIVO 10 software and thematically analysed.Findings: Forty parents (26 mothers and 14 fathers) of 30 children (14 girls and 16 boys aged 1-13 years) from three Australian States participated. The majority of children were Australian born. Three main themes with sub-themes were identified: navigating the crisis of child injury; coming to terms with the complexity of child injury; and finding ways to meet the family's needs.Conclusions: There is a need for targeted psychological care provision for parents of critically injured children in the acute hospital phase, including psychological first aid and addressing parental blame attribution. Parents and children would benefit from the implementation of anticipatory guidance frameworks informed by a family-centred social ecological approach to prepare them for the trauma journey and for discharge. This approach could inform care delivery throughout the child injury recovery trajectory. The development and implementation of a major trauma family support coordinator in paediatric trauma centres would make a tangible difference to the care of critically injured children and their families. [ABSTRACT FROM AUTHOR]